Provider Demographics
NPI:1467645028
Name:WESTON DAVIS
Entity Type:Organization
Organization Name:WESTON DAVIS
Other - Org Name:EAGLE AMBULANCE LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WESTON
Authorized Official - Middle Name:K
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:EMTP
Authorized Official - Phone:832-205-3180
Mailing Address - Street 1:PO BOX 1499
Mailing Address - Street 2:
Mailing Address - City:MONT BELVIEU
Mailing Address - State:TX
Mailing Address - Zip Code:77580-1499
Mailing Address - Country:US
Mailing Address - Phone:832-205-3180
Mailing Address - Fax:281-303-0294
Practice Address - Street 1:4922 COTTON LAKE RD
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77520-9820
Practice Address - Country:US
Practice Address - Phone:832-205-3180
Practice Address - Fax:281-303-0294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-27
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX191339401Medicaid
TXAMB905OtherBCBS
TX191339401Medicaid
TXAMB642Medicare PIN